Modificação do unsupported upper limb exercise test e avaliação de suas propriedades psicométricas em indivíduos com síndrome pós-covid-19

Abstract

The post-COVID-19 syndrome, caused by the SARS-CoV-2 virus, causes a systemic reaction due to the inflammatory cascade induced by the infection and the prolonged use of corticosteroids, especially in individuals passing through intensive care units (ICU). Some symptoms are commonly observed in the post-COVID19 syndrome, such as dry cough, dyspnea, fatigue, joint pain, in addition to others related to systemic involvement that affect functional capacity. Because of this, it is recommended that these individuals be referred to rehabilitation programs that act on functionality, individually, and after a careful assessment of their functional capacity. The assessment of functional capacity is commonly performed by field tests, however, to date, to the best of our knowledge, tests that assess upper limb functionality (MMSS) for post-COVID-19 individuals have not been validated. The Unsupported Upper Limb Exercise test (UULEX) is an incremental test designed to assess the exercise capacity of the upper limbs by increasing the load and range of motion of the upper limbs. However, studies have shown that subjects evaluated by UULEX do not reach higher levels and discontinue the test early due to fatigue. Therefore, the modification of the test seems to be a good strategy to better investigate the upper limb exercise capacity of these individuals. Also, as a result of the pandemic and the need for restrictions and social distancing, the remote care system and telemedicine gained greater prominence in the health area. However, to the best of our knowledge, upper limb functional tests (ULL) have not been widely studied in this type of care. In this way, article 1 presents a methodological study on the modification of the UULEX and its validation (UULEXM). Sixty-four individuals with post-COVID-19 syndrome with a mean age of 61±14 years underwent the original test and the modified version in person. No significant differences were observed for the physiological variables and symptoms between the tests (p>0.05), except for heart rate at the end of the test (4bpm; 0.9 to 7.42; p=0.013), but it was not clinically relevant. A strong correlation was observed between the test times (rho=0.872; p<0.001), despite the shorter time for the modified version (3.97min; 3.4 to 4.55; p<0.001). There was also a significant difference between sexes, where men had a longer test time compared to women (p<0.001). Considering the importance of social distancing at this time of a pandemic and the need for further investigations regarding the modality of online care, the validation of the test application remotely and the verification of responsiveness to a pulmonary telerehabilitation program were addressed in article 2. Recently, a quick review showed the possibility of applying functional tests, which assess only the lower limbs, remotely, but with some reservations regarding safety and the impossibility of prescribing exercises based on the tests. Article 2 of this dissertation evaluated 26 individuals with post-COVID-19 syndrome and no statistically significant difference was observed between the modified test applied in person and remotely (p>0.263). As for responsiveness, a group of 44 individuals, participants of a low-cost pulmonary telerehabilitation program that involved aerobic and resistance training, a standardized, the modified online test was able to identify a change in the test time (3.77min; 2, 43 to 5.11; p<0.001), dyspnea (-2.55; -3.51 to -1.59; p<0.001) and perceived exertion (-1.18; -2.22 to - 0.14; p=0.032), after eight weeks of intervention with a very large effect size (Cohen's d: 1.09) for the test time performed. Overall, this study suggests that the UULEX-M is a good test to assess the resistance exercise capacity of the upper limbs in individuals with post-COVID-19 syndrome, in addition to being more practical and requiring less time and material, being an alternative for use in clinical practice in home assessments, in rehabilitation centers and hospitals.